Part two - anatomy Flashcards
What are the boundaries of the cubital fossa?
Superior - line joining humeral condyles
Medial - radial border pronator teres
Lateral - ulnar border brachioradialis
Floor - brachialis and supinator
Roof - deep fascia of forearm reinforced medially by bicipital aponeurosis over which lies median cubital vein and medial cutaneous nerve of the forearm
What are the contents of the cubital fossa?
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- Biceps tendon
- Brachial artery
- Median nerve
If brachioradialis retracted and see radial nerve and its posterior interosseous branch which gives branches to ECRB and supinator.
Contents of anterior compartment of leg
Muscles
* Tibialis anterior
* Extensor hallucis longus
* Extensor digitorium longus
* Peroneus tertius
Nerve
* Deep perineal nerve
Artery
* Anterior tibial arteryOrder of anterior structures at the ankle
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From the Medial Malleolus going laterally
* Tibialis anterior * Extensor Hallucis longus * Anterior tibial Artery * Deep perineal Nerve * Extensor Digitorium longus * Peroneus Tertius
Contents of the lateral compartment of the leg
Muscles
* Peroneus longus
* Peroneus brevis
Nerve
* Superficial peroneal nerveWhat are the layers of the chest wall you go through to place a chest drain?
Skin Subcutis External intercostal muscle Internal intercostal muscle Innermost intercostal muscle Endothoracic fascia Parietal pleura Pleural cavity
Blood supply to diaphragm
Superior phrenic a - thoracic aorta
Inferior phrenic a - abdominal aorta
Musculophrenic a - internal thoracic artery
What is the Cernea Classification?
Classification for the relationship between the ESLN and the superior thyroid vessels:
- Type I = nerve crosses ST vessels >1cm above upper pole
- Type IIa = nerve crosses STV < 1cm above upper pole
- Type IIb = nerve crosses at or below level of upper pole
Constrictions of the oesophagus
15cm - cricopharyngeus at C6
22cm - aortic arch
27cm - left main bronchus
38cm - hiatus at T10
Embryology of oesophagus
Shares common embryologic origin with the trachea which it separates from at 6 weeks
Structure of the oesophagus
Stratified squamous epithelium Muscular layers - inner circular, outer longitundinal * Upper 1/3 striated * Middle 1/3 mixed * Lower 1/3 smooth
What is the phrenoeophageal ligament?
Fascial cone of transversalis fascia on the undersurface of the diaphragm which extends through the oesophageal opening and blends with the endothoracic fascia above the diaphragm.
It is attached to the oesophagus 2-3cm above GOJ.
Pectoralis minor
3rd-5th ribs -> coracoid process
Divides axillary artery into three parts
Lateral and medial pectoral nerves
Serratus anterior
Digitations first 8 ribs near costal cartilages
Medial scapular border
Long thoracic nerve = C5-7
Subscapularis
Costal scapular surface
Lesser tuberosity of humerus
Subscapular nerves
Teres major
Scapular inferior angle -> bicipital groove
Lower sub scapular nerves
Actions of latissimus dorsi
Extends, adducts and medially rotates arm
Iliopectineal arch
- strong fascia overlying iliopsoas muscle
- divides space deep to inguinal ligament into two
- blends with inguinal ligament in front
- blends with pectineal ligament behind
Ilipoubic tract
The inguinal ligament of the transversalis fasci
* arises from iliopetineal arch * runs parallel with but deeper than inguinal ligament * curves around femoral vessels and canal * blends with pectineal ligament * forms anterior and medial walls of femoral sheath
Why are patients at risk of a direct inguinal hernia after open appendicectomy
Lowermost fibres of IOM and transversus supplied by L1 nerves which if divided can lead to a direct hernia due to bulging of the conjoint tendon with increased intra-abdominal pressure. At the level of the inguinal canal, however, the ilioinguinal is purely a sensory nerve (anterior scrotum/labia and adjacent thigh).
Ilioinguinal - 2cm superomedial to ASIS
Iliohypogastric - 3cm superomedial to ASIS
External oblique muscle
Lower 8 ribs anterior angles (5-12) Anterior half iliac crest, xiphisternum, PS & crest, linea alba 3 free edges - posteriorly - inguinal ligament - between 5th rib and xiphi superiorly T7-12 intecostal nerves
Internal oblique
Costal margin, rectus sheath , linea alba
Anterior 2/3 iliac crest, lateral 2/3 inguinal ligament, lumbar fascia
Conjoint tendon to pubic crest and pectineal line
T7-T12 & ilioinguinal nerve (L1) to conjoint tendon
Fibres at right angles to EOM - up and medial
Transversus abdominis
Costal margin, rectus sheath, linea alba
Anterior 2/3 iliac crest, lateral 1/2 inguinal ligament, lumbar fascia
Conjoint tendon to pubic crest and pectineal line
Transverse fibres
T7-T12 & ilioinginal nerve to conjoint tendon
Rectus abdominis
Costal cartilages 5-7, costal margin, sternum, diaphragm
Pubic crest, tubercle and symphysis
T7-12
3 tendinous intersections fused to anterior rectal sheath
- xiphi
- umbo
- halfway
Pyramidalis
Front of pubis body to line alba
T12 (subcostal)
Blood supply to the nipple
Periareolar subcutaneous plexus supplied by:
Superficial branches of internal and lateral thoracic arteries from above
Branches of the lower intercostal vessels from below
Pectoralis major
Three origins
- Medial half of clavicle, deltopectoral groove
- Lateral half of sternum
- 2nd-6th costal cartilages
Inserts into bicipital groove
Medial (C8) and lateral pectoral nerves (C6-7) which paradoxically innervate the lateral and medial fibres respectively
Lumbar plexus
T12 - subcostal L1 - iliohypogastric & ilioinguinal L1,L2 - genitofemoral L2,L3 - lateral femoral cutaneous L2-4 posterior divisions - femoral nerve L2-4 anterior divisions - obturator nerve L4,L5 - lumbosacral trunk
Genitofemoral nerve
L1,L2
Pierces psoas and runs on it
Genital branch enters cord with cremasteric vessels
Lies posterior to cord
Supplies cremaster muscle and skin of scrotum/labia and medial thigh
Branches of the external iliac artery
Deep circumflex artery
Inferior epigastric artery
–> cremaster artery
–> superior pubic branch
Femoral sheath
Pectineal ligament and pectineus fascia posterolaterally Transversalis fascia anteromedially Divided into three compartments: - Lateral --> artery - Middle --> vein - Medial --> femoral canal
Ends 4cm below inguinal ligament by fusing with the adventitia of the vessels
Pancreatic divisim
Most common congenital pancreatic anomaly
7% in autopsies
Failure of fusion of the ventral and dorsal ductal systems
Annular pancreas
Uncommon
Complete ring of pancreatic tissue around D2 resulting from failure of ventral bud to rotate with duodenum
Children present with duodenal obstruction
Adults - peptic ulcers, duodenal obstruction, acute or chronic pancreatitis, obstructive jaundice
